Denver Police Department Retiree Benefits Guide

Transcription

1 Denver Police Department Retiree Benefits Guide Effective January 1, December 31, 2017

2 Department of Public Safety Denver Police Department TABLE OF CONTENTS Retiree Benefits Overview 2 Basic Benefit Definitions 4 Under 65 Medical Plans Overview 5 Under 65 Medical Plans 6 Health Savings Account 15 Over 65 Medical Plans 16 Over and Under 65 Dental Plans 18 Over and Under 65 Vision Plan 19 Rates 20 Contact Information 21 Cover Photo courtesy of Marella McCarthy 1

3 Retiree Benefits Overview 2017 Retiree Benefits Guide This benefits guide provides a comprehensive overview of eligibility, the election period and costs. In addition, this guide offers descriptions and detailed explanations of each medical, dental and vision plan. We encourage you to carefully consider all aspects of these plans, including their premiums, accessibility to health care services, flexibility and restrictions. Ultimately, it is up to you to determine the benefits that best suit the needs of you and your family Benefits Changes Below is a list of key changes for 2017: Premiums for medical plans have increased The City will replace the current vision plan with Humana Vision 2016 Open Enrollment Information Retiree Open Enrollment is from Saturday, October 1 to Friday, November 4, 2016 All changes to your elections must be submitted via an enrollment form to the Department of Public Safety Human Resources Division (Safety HRD), (1331 Cherokee Street #408, Denver, CO 80204) by Friday, November 4, No changes can be made to your enrollment status after this date unless you have a qualifying change in family status Any changes or new enrollments will be effective Sunday, January 1, Sunday, December 31, 2017 What You Need to Do Read this benefits guide carefully Attend the Annual Open Enrollment Benefits Fair, if you wish, to obtain important information about your benefits. Submit your completed enrollment form(s) to the Safety HRD within 30 days of retirement, or by Friday, November 4, 2016 If you are newly enrolled in UHC Navigate, you must choose a Primary Physician (PCP). In order to see the doctor of your choice, ccdnavigate@uhc.com with your PCP s 11 digit Provider ID. You can find the Provider ID by going to clicking Find Physician, Laboratory or Facility and then selecting the UnitedHealthcare Navigate/Navigate Balanced plan and searching for your PCP Available Resources The following resources are available to assist you in the enrollment process: 1. Provider websites and Toll Free Numbers each carrier website contains valuable information regarding the benefit plan and an up-to-date list of participating providers. Refer to Page 21 for additional information. 2. If you have questions regarding a Fire and Police Pension Association (FPPA) sponsored plan, please contact the FPPA at or or 3. For general enrollment questions, please contact the Safety HRD at Your Benefit Choices The Denver Police Department offers the following benefits to Retired Police Officers: Medical Plans Under 65: Denver Health Medical Plan (DHMP), Kaiser Permanente (Kaiser) and UnitedHealthcare will continue to offer a HMO/Choice Co-Pay plan and a high health plan (HDHP) Over 65: Kaiser Senior Advantage, UHC Medicare Advantage and UHC Senior Supplement Dental Plan Delta Dental Vision Plan Humana Vision 2

4 Department of Public Safety Denver Police Department Eligible Dependents Eligible dependents include the following: Your spouse, if not legally separated (including those defined as common law, and same-sex legally married) Your Colorado state civil union spouse Your same gender spousal equivalent (pre-tax or after-tax depending on marriage status) Children under the age of 26, yours or your spouse s Dependent children of any age who are handicapped and totally disabled (verification form required) Children under your legal guardianship Dependent documentation is required for newly enrolled dependents. Supporting documentation must also be provided as proof of any life event change. Choosing a Coverage Level You may elect different coverage levels under the medical, dental, and/or vision plan(s). For example, you may elect Retiree only coverage under the medical plan and family coverage under the dental plan. This flexibility allows you to best meet your needs. The coverage levels are as follows: Retiree only Retiree + Family or Retiree + Spouse Waive (cannot re-enroll without a qualified status change) Retiree + Children Examples of qualifying Change in Family Status events Marriage Birth or adoption Legal separation or divorce Change in your spouse s employment or health benefits Death New Common Law/Domestic Partner Relationship If you experience a Change in Family Status 1. You must notify the Safety HRD within 30 days of the status change in order to add or delete a dependent or make other changes. 2. Supporting documentation is required. 3. If you miss the 30 day window, you cannot make changes until the next Annual Enrollment period. Health Reform Law Individual Mandate You and your family members are required to have health insurance or pay a penalty to the government. If you don t have coverage, you ll have to pay a penalty of $695 per adult and $ per child, or 2.5% of your income (whichever is greater). Beginning in 2017, the penalties will increase by the cost-of-living adjustment. Some people may qualify for an exemption to this fee. The Denver Police Department medical plans meet all the health reform law requirements to satisfy the individual mandate. If you are covered by any of the following in 2017, you will meet the individual mandate requirements: a Denver Police Department medical plan, your parent s or spouse s employer plan, an individual policy, a government plan such as Medicare, Medicaid, CHIP, TRICARE, or veterans coverage, student health coverage, state highrisk pool coverage, or coverage for non-u.s. citizens provided by another country. Learn more about the health reform law requirements at 3

5 Basic Benefit Definitions 2017 Retiree Benefits Guide Coinsurance Coinsurance is a set percentage of service costs that you will be expected to pay once you have met your annual. When your annual is met, the provider then shares the cost of your service with you. For example, if your coinsurance is 20% for a procedure, you will pay 20% of the full cost for that service and the provider pays the remaining 80% of the full cost, after you have met your annual. All your coinsurance payments count towards your out-of-pocket maximum. Co-pays Co-payments or co-pays, as they are commonly called, are a preset dollar amount you are expected to pay for office visits, medical procedures or prescription drugs under your insurance plan. All co-pays count towards your out-ofpocket maximum. Co-pays do not count towards your. Deductible A is the amount you pay out of pocket before your insurance pays. The is within a calendar year and once you have met that dollar amount, you have met the requirement for the year. For example, if you have a of $500, you are required to pay that amount before the insurance begins to pay their percentage of the costs. All s count towards your out-of-pocket maximum. Health Savings Account (HSA) A HSA is a personal health care savings account that an employee can use to pay out-of-pocket health care expenses with pre-tax dollars. Their contributions are tax free, and the money remains in the account for the employee spend on eligible expenses no matter where they work or how long it stays in the account. High Deductible Health Plan (HDHP) HDHP plans have no copays for service (with the exception of pharmacy services); instead members are responsible for paying for all non-preventive costs to a preset. Preventive care is always covered at 100%. Once the is met, members pay a percentage of the remaining costs, called coinsurance. After you meet your, you pay coinsurance until you meet your out-of-pocket maximum (OPM). You will not have copays at the time of service (with the exception of pharmacy services); however, you will receive an explanation of benefits (EOB) from the provider within a couple of months for services rendered. You are responsible for paying the member amount owed. Out-of-pocket Maximum (OPM) An out-of-pocket maximum is an annual cap on the dollar amount you are expected to pay out of your own pocket for services (including co-pays, s and coinsurance) throughout the plan year. These annual caps are set for a single person and for a family. Once the out-of-pocket maximum is met, the insurance will cover at 100% and you are no longer required to pay for any medical expenses. Per Occurrence Deductible A per occurrence is a fee charged by Denver Health for each individual inpatient or outpatient hospital service. (Denver Health DHMO plan only) All per occurrence s count towards your out-of-pocket maximum. Explanation of Benefits (EOB) A tracking document for each date of service outlining status and out-of-pocket tracking per covered member. 4

6 Department of Public Safety Denver Police Department Under 65 Medical Plans Overview You can select medical coverage from three different providers: Denver Health Medical Plan (DHMP), Kaiser Permanente (Kaiser) and UnitedHealthcare (UHC). Each of the providers offers two distinct types of medical plans: HDHP Deductible/Coinsurance/Out-of-Pocket Maximum plans DHMO Copay/Deductible/Coinsurance plans The main difference between an HDHP and DHMO is how and when you pay for your health care. High Deductible Health Plan (HDHP) With an high- health plan HDHP, your monthly contribution from your check will be lower, but you will have s (the amount you pay before the medical plan pays for services) and coinsurance (the portion of medical services that you share with the insurance company). If you enroll in one of the HDHP plans, you are eligible to open and fund a health savings account (HSA). A HSA is a savings account to help you pay for your medical expenses. Deductible HMO (DHMO) DHMO plans include copays, s and coinsurance for some services. Depending on the service received, you may have to meet your and pay coinsurance costs after the service. 5

7 Under 65 Medical Plans 2017 Retiree Benefits Guide Denver Health Medical Plans (DHMP) Denver Health has contracted with University of Colorado Hospital and Children s Hospital Colorado. received at these facilities (or by a contracted provider) will be covered at the same level as other in-network services. Denver Health has also contracted with Cofinity, a nationwide provider network. received by a Cofinity provider or at a Cofinity facility are covered under the Cofinity tier (see table above for Cofinity tier benefit details). provided by a non-contracted provider or at a non-contracted facility are not covered (except in the case of a medical emergency). Summary of Covered Benefits DHMP HDHP Cofinity In-Network Network DHMP DHMO Cofinity In-Network Network Plan Year Deductible Individual/Family $1350/$2700 $1350/$2700 $500/$1500 $750/$1750 Out-of-Pocket Max Includes, coinsurance and copays Individual/Family $2700/$5400 $2700/$5400 $3000/$6000 $3000/$6000 Lifetime None None None None Maximum Preventive Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Prescription Drugs Generic/ Formulary/ Non-formulary See plan summary for details, costs vary by pharmacy location and Rx tier. (Prescriptions must be written by a Denver Health provider in order to be filled by a Denver Health Pharmacy.) 6 (continued on next page)

8 Department of Public Safety Denver Police Department Summary of Covered Benefits Physician Primary DHMP HDHP Cofinity In-Network Network DHMP DHMO Cofinity In-Network Network $25 copay $30 copay Specialist $50 copay Additional services will require co-payment or and coinsurance $50 copay Additional services will require co-payment or and coinsurance Urgent $75 copay (Deductible and coinsurance do not apply) $75 copay (Deductible and coinsurance do not apply) Mental Health Outpatient $50 copay $50 copay Inpatient * * per occurrence of $150 and annual have been met* Plan pays 70% after per occurrence of $150 and annual have been met* Hospital Inpatient/ Outpatient * * per occurrence copay of $150 and annual are met* Plan pays 70% after per occurrence copay of $150 and annual are met* Lab/X-ray Diagnostic Lab/X-Ray High-Tech MRI, CT, PET for labs, X-ray and CT, $150 copay per visit for MRI and PET scans Plan pays 70% after for labs, X-ray and CT, $200 copay per visit for MRI and PET scans Emergency Room $300 copay (Deductible and coinsurance do not apply) $300 copay (Deductible and coinsurance do not apply) (continued on next page) 7

9 2017 Retiree Benefits Guide Summary of Covered Benefits Prenatal and Postnatal DHMP HDHP Cofinity In-Network Network DHMP DHMO Cofinity In-Network Network No charge No charge Delivery and all Inpatient Skilled Nursing Facility Hospice Home Health Durable Medical Equipment Chiropractic ; Maximum benefit is 100 days per calendar year* * for prescribed medically necessary skilled home health services* ; Maximum benefit is $2000 per calendar year* ; Maximum 20 visits per calendar year; must be provided by Columbine Chiropractic ; Maximum benefit is 100 days per calendar year* * * ; Maximum benefit is $2000 per calendar year* ; Maximum 20 visits per calendar year; must be provided by Columbine Chiropractic per occurrence of $150 and annual have been met ; Maximum benefit is 60 days per calendar year* * ; Maximum benefit is 60 days per calendar year* ; Maximum benefit is $2500 per calendar year $50 copay; Maximum 20 visits per calendar year; must be provided by Columbine Chiropractic Vision $25 copay; 1 Exam every 24 months Plan pays 70% after per occurrence of $150 and annual have been met Plan pays 70% after : Maximum benefit is 60 days per calendar year* Plan pays 70% after * Plan pays 70% after ; Maximum benefit is 60 days per calendar year* Plan pays 70% after ; Maximum benefit is $2500 per calendar year $50 copay; Maximum 20 visits per calendar year; must be provided by Columbine Chiropractic $35 copay; 1 Exam every 24 months *Prior authorization required After Hours Options Options for when you are sick and need care today: Call NurseLine Advice DispatchHealth will come to you. DispatchHealth is our on-demand health care provider that can treat a range of injuries and illnesses in the comfort of your home. Download the free app or call Visit a Walgreens Healthcare Clinic or a King Soopers Little Clinic. These clinics are a good option if you have a sore throat, sinus infection or the flu. Visit an Urgent center that is convenient for you. You are covered anywhere in the U.S. Emergency Room. If you need emergency care, go to the nearest hospital or call You are covered at any Emergency Room for emergency care at any time. To learn more about DHMP, visit or call Member at

10 Department of Public Safety Denver Police Department Kaiser Permanente Plans (Kaiser) Choose the Right Doctor For You If you enroll in the Kaiser Permanente HDHP or DHMO, you must select a primary care physician who is responsible for overseeing your health care. Kaiser Permanente medical offices are located across the Denver/Boulder area, making it easy to find a doctor who is close to your home or workplace. Most Kaiser medical offices house primary care, laboratory, X-ray and pharmacy services under one roof, which means you can visit your physician and manage many of your other needs in a single trip. The Kaiser plans provide in-network coverage only (except in the case of a medical emergency). Call the Appointment and Advice Line If you have an illness or injury and you re not sure what kind of care you need, Kaiser advice nurses can help. They can assess your situation and direct you to the appropriate facility, or even help you handle the problem at home until your next appointment. For advice, call hours a day, seven days a week. For appointment services, call Monday through Friday from 7:00 a.m. - 6:00 p.m. Summary of KAISER HDHP KAISER DHMO Covered Benefits In-Network Out-of-Network In-Network Out-of-Network Plan Year Deductible Individual/Family $1350/$2700 $500/$1500 Out-of-Pocket Max Includes, coinsurance and copays Individual/Family $2700/$5400 $3000/$6000 Lifetime None N/A None N/A Maximum Preventive Plan pays 100% Plan Pays 100% Prescription Drugs Generic $10 copay after $20 copay Formulary $35 copay after $40 copay Non-formulary $60 copay after $60 copay (continued on next page) 9

11 2017 Retiree Benefits Guide Summary of Covered Benefits Physician Primary KAISER HDHP KAISER DHMO In-Network Out-of-Network In-Network Out-of-Network $30 copay** Specialist $50 copay** Urgent Urgent only when authorized $75 copay** Urgent only when authorized Mental Health Outpatient $30 copay Inpatient Hospital Inpatient/ Outpatient Urgent/Emergency only when authorized Urgent/Emergency only when authorized Lab/X-ray Diagnostic Lab/X-Ray High-Tech MRI, CT, PET Labs are no charge. for X-ray and MRI, CT/PET scans Emergency Room Emergency only when authorized $200 copay Emergency only when authorized Prenatal and Postnatal Delivery and all Inpatient Skilled Nursing Facility for a maximum of 100 calendar days for a maximum of 100 calendar days per year Hospice (continued on next page) 10

12 Department of Public Safety Denver Police Department Summary of Covered Benefits Home Health Durable Medical Equipment Chiropractic Vision KAISER HDHP KAISER DHMO In-Network Out-of-Network In-Network Out-of-Network ; coverage is limited to less than 8 hours per day and 28 hours per week ; coverage is limited to items on our DME formulary; prosthetic arms and legs not to exceed 20% coinsurance ; Maximum 20 visits per calendar year ; hardware is not covered ; coverage is limited to less than 8 hours per day and 28 hours per week coverage is limited to items on our DME formulary; prosthetic arms and legs not to exceed 20% coinsurance $30 copay; Limit 20 visits per calendar year $30 copay; hardware is not covered *Prior authorization required **(20% coinsurance after for covered services received during a visit) E-Visits Now Available Manage your health online with the new e-visit secure feature of My Health Manager. E-Visits new online medical consultations If you have a non-urgent medical condition at any time 24/7 and you re not sure what kind of care you need, an e-visit may be a good option for you. An e-visit is an online medical consultation with a Kaiser Permanente Advice Call Center Registered Nurse that s available at no cost for select medical conditions like nausea/vomiting, pink eye, female UTI, sinus, constipation, diarrhea, and more. Complete an E-Visit Log on to kp.org. Then, go to My Health Manager and then the Appointment Center From there, choose the appropriate medical condition that best describes your symptoms Complete and submit the series of questions An Advice Call Center Registered Nurse will respond within four hours of receiving your questionnaire. For your safety, some answers during your e-visit may prompt you to call the Appointment and Advice Call Center directly in order to expedite your care. If this happens, call the Appointment and Advice Call Center for medical advice immediately, at or (TTY for the deaf, hard of hearing, or speech impaired:711) Not registered for kp.org yet? Go to kp.org/registernow and follow the prompts. Once registered you ll be able to your doctor s office, complete an e-visit, pay medical bills, view lab results, and more! To learn more about Kaiser and their facilities, go to or call

13 2017 Retiree Benefits Guide UnitedHealthcare Plans (UHC) High Deductible Health Plan (HDHP) The UnitedHealthcare HDHP provides in- and out-of-network coverage, allowing you the freedom to choose any provider. However, you will pay less out of your pocket when you choose a UnitedHealthcare network provider. Navigate If you enroll in the UnitedHealthcare Navigate DHMO, you must select a primary care physician (PCP) who will provide and manage most of your care. You must receive an electronic referral before seeing another network PCP or specialist. During enrollment, select your PCP from UnitedHealthcare s Navigate network. You must your PCP s UHC ID number to ccdnavigate@uhc.com. If you do not select a PCP, UnitedHealthcare will assign one. The UnitedHealthcare Navigate plan provides in-network coverage only (except in the case of a medical emergency). Summary of Covered Benefits UHC HDHP UHC DHMO Navigate In-Network Out-of-Network In-Network Out-of-Network Plan Year Deductible Individual/Family $1350/$2700 $3000/$6000 $500/$1500 Out-of-Pocket Max Includes, coinsurance and copays Individual/Family $2700/$5400 $6000/$12000 $3000/$6000 Lifetime None None None None Maximum Preventive Plan pays 100% Plan pays 100% Plan pays 100% Prescription Drugs Deductible, then: Deductible, then: Deductible, then: Tier 1 $10 copay $10 copay $15 copay Tier 2 $35 copay $35 copay $45 copay Tier 3 $60 copay $60 copay $60 copay (continued on next page) 12

14 Department of Public Safety Denver Police Department Summary of Covered Benefits Physician Primary UHC HDHP UHC DHMO Navigate In-Network Out-of-Network In-Network Out-of-Network $25 copay Specialist $50 copay Urgent $75 copay Mental Health Outpatient $50 copay Inpatient* Hospital Inpatient/ Outpatient ; $150 inpatient stay per occurrence applies prior to the annual ; $75 outpatient surgery per occurrence applies prior to the annual Lab/X-ray Diagnostic Lab/X-Ray High-Tech MRI, CT, PET for labs and X-ray $150 copay per visit for MRI and CT/ PET scans Emergency Room $300 copay $300 copay Prenatal and Postnatal No Charge No Charge Delivery and all Inpatient (continued on next page) 13

15 2017 Retiree Benefits Guide Summary of Covered Benefits Skilled Nursing Facility Hospice Home Health Durable Medical Equipment Chiropractic Vision *Prior authorization required UHC HDHP UHC DHMO Navigate In-Network Out-of-Network In-Network Out-of-Network $50 copay; Limit 20 visits per year ; hardware is not covered $25 copay; hardware is not covered Virtual Visits Members log on to myuhc.com where they can: Learn more about virtual visits (e.g., how to use it, a covered benefit, etc.) View virtual visit provider group choices Members can access virtual visit provider groups through myuhc.com or from their mobile device, computer or telephone To find out more about UHC, visit or call

16 Department of Public Safety Denver Police Department Health Savings Account A HSA is a personal health care savings account that you can use to pay out-of-pocket health care expenses with tax free dollars. Your contributions are tax free, and the money remains in the account for you to spend on eligible expenses HSA Guidelines as established by the IRS The IRS limits how much you can put into your HSA each year. The 2017 limits are: Individual coverage $3400 All other tiers $6750 Catch-up contribution (if age 55+) $1000 HSA Eligibility You are eligible to open and fund a HSA if: You are enrolled in one of our three HDHP plans You are not covered by a non-high- health plan, health care FSA, or health reimbursement arrangement You are not eligible to be claimed as a dependent on someone else s tax return You are not enrolled in Medicare or TRICARE for Life You have not received Veterans Administration Benefits in the last three months Use Your HSA to Pay for Qualified Medical Expenses You can use your HSA money to pay for eligible expenses now or in the future Funds from a HSA can be used for your expenses and those of your spouse and eligible dependents, even if they are not covered by a HDHP Eligible medical expenses including s, doctor s office visits, dental expenses, vision expenses, prescription expenses, and LASIK eye surgery A complete list of eligible expenses can be found at A HSA is an individually owned account You own and administer your HSA You determine how much you will contribute to your account and when to use the money to pay for eligible health care expenses You can change your contribution at any time during the plan year without a qualifying event Like a bank account, you must have a balance in order to pay for eligible health care expenses You should keep all receipts for tax documentation A HSA allows you to save and roll over money from year to year The money in the account is always yours The money in a HSA (including interest and investment earnings) grows tax free Opening Your HSA You can open your HSA at any financial institution that offers health savings accounts. There may be a monthly service fee associated with your account. Rocky Mountain Law Enforcement Federal Credit Union has agreed to administer HSAs for credit union members at no charge. To open your account with the credit union, you need to visit one of their locations listed below. If you have questions, please contact the credit union. Denver (Main Office) Aurora Lone Tree 700 W 39th Ave Denver, CO N Potomac Cir Aurora, CO Park Meadows Dr Lone Tree, CO Phone: Call Center: Call Center: Toll Free: Toll Free: Toll Free: Fax: (303) Fax: Fax:

17 Over 65 Medical Plans 2017 Retiree Benefits Guide To enroll in either the Kaiser Senior Advantage plan or UHC Medicare Advantage you must: be entitled to Medicare Part A and enrolled in Part B be age 65 or older or disabled reside in the Kaiser Service Area of Denver, Boulder, Colorado Springs and Pueblo reside in the UHC Medicare Advantage Service Area To enroll in UHC Senior Supplement plan you must: be entitled to Medicare Part A and enrolled in Part B be age 65 or older or disabled Please contact your medical provider for a zip code and county listing of the Service Area. Benefit Summary Kaiser Senior Advantage Group # UHC Medicare Advantage with Part D Group # UHC Senior Supplement Group #02629 with Part D (prescription) Group #01377 Out of Pocket Maximum $2500 $2000 Unlimited Office Visits Primary $20 $10 $20 Specialty Preventive Routine Physical Exam Preventive Hearing Exam Medicare covered Vision Exam Hospital Inpatient Outpatient Surgery Emergency Room Urgent Facility Ambulance Lab & X-ray Lab tests, diagnostics $30 $20 $20 $250 per day ($500 max) $200 for Medicare covered $50 (waived if admitted) $30 20% up to $195 per trip $20 $20 $200 $100 $50 (waived if admitted) $35 (in network) $50 $20 $10 $10 up to 365 days $50 (waived if admitted) MRI, PET, CT scans $100 per procedure $25 per procedure Prescriptions (30-day supply) (30-day supply) (30-day supply) Generic/Tier 1 $15 $10 $10 Preferred Brand/Tier 2 Non-Preferred/Tier3 Mail Order $25 $25 Enrolled in Medicare Part D 2x retail co-pay (90-Day Supply) $40 $75 Enrolled in Medicare Part D 2x retail co-pay (90-Day Supply) $20 $35 Enrolled in Medicare Part D 2x retail co-pay (90-Day Supply) Lifetime Max Benefit Unlimited Unlimited Unlimited (continued on next page)

18 Department of Public Safety Denver Police Department Benefit Summary Kaiser Senior Advantage Group #00068 UHC Medicare Advantage with Part D Group # Skilled Nursing Facility up to 100 days per day; days 1-20; $50 per additional day up to 100 days UHC Senior Supplement Group #02629 with Part D (prescription) Group #01377 per day; days Durable Medical 20% coinsurance (1) 20% coinsurance Oxygen 20% coinsurance Vision Hardware Charges over $100 benefit, every 2 years $70 frame allowance, lenses, every 24 months $105 contact lens allowance, every 24 months Not covered Hearing Aids $500 (every 36 months) $250 Silver Sneakers Fitness 1. Authorization rules may apply. There is no charge for diabetic self-monitoring training, nutrition therapy and supplies. 17

19 Over and Under 65 Dental Plans 2017 Retiree Benefits Guide Three dental plans are available to retirees of the Denver Police Department and their eligible dependents through Delta Dental - the Low, Medium and High Plans. When you choose to visit an in-network (PPO) dentist you maximize your benefit plan with lower out-of-pocket expenses. In-network dentists have agreed to accept Delta Dental reimbursement as full payment for services rendered. If an out of network provider is used, expenses are reimbursed based on reasonable and customary (R&C) charges, and any charges over the R&C are your responsibility. Delta Dental Low Plan Group #7952 Benefit Summary In-Network or Out-of-Network (1) Annual Deductible $100 per person Preventive 70% after Basic 50% after Major (12-24 month waiting period (2) ) 30% after Annual Max Benefit $1000 per member Delta Dental Medium Plan Group #7953 Benefit Summary In-Network or Out-of-Network (1) Annual Deductible $75 per person Preventive 80% after Basic 60% after Major (12-24 month waiting period (2) ) 40% after Annual Max Benefit $1000 per member Delta Dental High Plan Group #7954 Benefit Summary In-Network or Out-of-Network (1) Annual Deductible $75 per person Preventive 100% after Basic 80% after Major (12-24 month waiting period (2) ) 50% after Annual Max Benefit $1500 per member 1. Reimbursement is based on the PPO allowable fee located in the PPO Discounted Fee Schedule and is contractually agreed upon between the PPO dentist and Delta Dental to accept for treating eligible persons under this plan. 2. Length of waiting period based on services provided. Waiting period waived for Retirees that enroll within 60 days of retirement. Plan Design: Delta Dental PPO-Voluntary MAC (Maximum Allowable Charge) includes PREVENTION FIRST RIDER Who can be covered: Retiree as defined by the employer, spouse and dependent children to age 26 When does coverage expire: Coverage will only be terminated at the request of the member or upon nonpayment of premium. If the retiree dies, the spouse can continue coverage as long as the spouse was covered in the retiree dental plan before the death of the retiree and continues to pay the premium To find out more about Delta Dental, visit or call

20 Department of Public Safety Denver Police Department Over and Under 65 Vision Plan The Denver Police Department offers you and your eligible dependents a vision insurance plan through Humana. You have the freedom to choose any vision provider. However, you will maximize the plan benefits when you choose a network provider. Locate a Humana network provider at The table below summarizes the key features of the vision plan. Please refer to the official plan documents for additional information on coverage and exclusions. Humana Vision Plan Benefit Summary In-Network Out-of-Network Eye Exam (every 12 months) $10 Up to $30 allowance Lenses (every 12 months,) Single Bifocal Trifocal Lenticular $15 $15 $15 $15 Up to $25 allowance Up to $40 allowance Up to $60 allowance Up to $100 allowance Frames (every 24 months) Up to $130 Allowance, 20% off Up to $65 retail allowance balance over $130 Contact Lenses* (every 12 months) Medically Necessary co-pay waived Up to $200 allowance Conventional Up to $130 allowance, 15% off balance over $130 Up to $104 allowance Disposable * Applies to materials only Up to $130 allowance Up to $104 allowance Lifestyle Discount Program This free discount program is available to all Denver Police Department Retirees regardless of them being on a Humana plan or not. In summary, the program provides discounts around the following health & wellness procedures: Acupuncture and Massage Therapy - up to 30% savings Prescription Drug Savings average savings of 37% Weight Loss 12% discount Lasik 15% off standard procedures, 5% off promotional prices Teeth Whitening up to 70% savings Identity Monitoring and Protection 3 available packages with discounts available To find out more about Humana, visit or call

21 2017 Retiree Benefits Guide Rates Medical Under 65 Retiree Monthly Rates Benefit Summary DHMP HDHP DHMP DHMO Kaiser HDHP Group #68-51 Kaiser DHMO Group #68-32 UHC HDHP Group # UHC Navigate Group # Retiree $ $ $ $ $ $ Retiree/ $ $ $ $ $ $ Spouse Retiree/ $ $ $ $ $ $ Children Retiree/Family $ $ $ $ $ $ Medical Over 65 Retiree Monthly Rates Kaiser Senior Advantage Benefit Summary Group #00068 (in area) UHC Medicare Advantage Group # UHC Senior Supplement Group #02629 with Part D (prescription) Group #01377 Retiree Only - One Medicare $ $ $ Retiree + Spouse - Two Medicare $ $ $ Retiree Only with Medicare Part B $ N/A N/A Only Retiree + Spouse (Child) - One $ $ $ Medicare one HDHP Retiree + Family - One Medicare HDHP $ $ $ Retiree + Family - Two Medicare HDHP $ $ $ Retiree + Spouse (Child) - One $ $ $ Medicare one DHMO or Navigate Retiree + Family - One Medicare $ $ $ (DHMO) or Navigate Retiree + Family - Two Medicare (DHMO) or Navigate $ $ $ Dental Plans Retiree Monthly Rates Benefit Summary Delta Dental Low Group #7952 Delta Dental Medium Group #7953 Delta Dental High Group #7954 Retiree Only $18.22 $25.02 $32.90 Retiree + 1 Dependent $34.61 $47.53 $62.51 Retiree and 2 or more Dependents $50.78 $68.62 $92.49 Vision Plan Retiree Monthly Rates Benefit Summary Humana Vision Plan Retiree Only $6.97 Retiree + 1 Dependent $13.97 Retiree + Family $

22 Department of Public Safety Denver Police Department Contact Information Provider/Plan Contact Number Website Medical Plan - DHMP or Medical Plan - Kaiser or Medical Plan - UHC or Dental Plan - Delta Dental or Vision Plan - Humana Fire and Police Pension or Association - (FPPA) Colonial Life Insurance or Police and Fireman s Insurance or PPA TIAA (Deferred Compensation Plan) Safety HRD safetyhr@denvergov.org Disclosure About the Benefit Enrollment Communications This document is intended to merely highlight or summarize certain aspects of the employer s benefit program(s). It is not a summary plan description or an official plan document. Your rights and obligations under the program(s) are set forth in the official plan documents. All statements in this summary are subject to the terms of the official plan documents, as interpreted by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a provision in this summary and a provision in the plan documents, the terms of the plan documents control. The employer reserves the right to review, change, or terminate the plan, or any benefits under it, for any reason, at any time and without advance notice to any person. Please note that this is a summary of benefits and does not constitute a policy. Detailed provisions are contained in each provider s plan document. If there is a discrepancy between what is presented here and the official plan documents, the plan documents will govern. Human Resources Division 1331 Cherokee Street # 408 Denver, CO SafetyHR@denvergov.org 21